| NPI | 1497223564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R257567) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024195305) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC NP500339034) | |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2025-11-10 |