| NPI | 1922453711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC001763) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC RN1031886) | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2016-08-21 |