| NPI | 1821347592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MD R178223) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: DC RN1011938) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2023-02-24 |