| NPI | 1073229324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VT 101.0135988) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VT 0260058988) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-02-09 |