| NPI | 1518458363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R177845) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DC RN1011899) |
| 363L00000X Nurse Practitioner (Licence: MD R177845) | |
| Enumeration Date | 2018-05-27 |
| Last Update Date | 2020-05-07 |