NPI | 1639522246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R215271) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1032225) |
Enumeration Date | 2016-07-19 |
Last Update Date | 2023-08-02 |