| NPI | 1972842144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DC RN1026533) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R200273) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2014-08-06 |