| NPI | 1851848279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R195854) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1021119) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |