| NPI | 1750784922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC RN1026434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1026434) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2023-08-04 |