| NPI | 1982060083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R214942) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1018157) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2025-03-19 |