| NPI | 1497252845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 344446) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: DC RN1008505) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2019-11-04 |