NPI | 1700320959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC NP500013225) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9347540) |
363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9347540) | |
Enumeration Date | 2016-12-07 |
Last Update Date | 2025-05-22 |