| NPI | 1023744406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024185745) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: TX 984504) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-01-09 |