| NPI | 1497723753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: DC RN68020) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DC RN68020) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2025-03-17 |