| NPI | 1790163830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R218721) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R218721) |
| 163W00000X Registered Nurse (Licence: DC RN1040225) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2024-02-21 |