| NPI | 1528508009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R198411) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DC RN1023603) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R198411) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2022-07-21 |