| NPI | 1669995437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: DC RN1011343) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN101143) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2021-05-18 |