| NPI | 1669045944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 24182322) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 348813) |
| 363L00000X Nurse Practitioner (Licence: MD AC004033) | |
| 363L00000X Nurse Practitioner (Licence: DC NP1057462) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2023-05-17 |