| NPI | 1720432172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DC RN1025737) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R199032) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2016-06-08 |