| NPI | 1912499708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R171946) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343701) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC RN1006294) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024181195) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-08-30 |