| NPI | 1891874129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC RN 57113) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024167576) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2009-01-21 |