| NPI | 1427813062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R249246) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC NP1057318) |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2025-05-22 |