| NPI | 1871995803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024178860) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 5007190) |
| 363LF0000X Nurse Practitioner Family (Licence: DC RN1049831) | |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2022-05-19 |