| NPI | 1912499708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DC RN1006294) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SD CP001403) |
| 363LF0000X Nurse Practitioner Family (Licence: MD R171946) | |
| 363LF0000X Nurse Practitioner Family (Licence: VA 0024181195) | |
| 363LF0000X Nurse Practitioner Family (Licence: NY 343701) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-03-05 |