| NPI | 1861270605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R236307) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DC NP1041492) |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2024-09-16 |