| NPI | 1801510516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R216697) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185610) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC NP500004965) | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2023-01-02 |