| NPI | 1558762062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R186285) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1040884) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2023-03-04 |