| NPI | 1720405111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1030827) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R197119) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2022-01-07 |