| NPI | 1669110136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DC NP1019062) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC NP1019062) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R234328) | |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2026-06-09 |