| NPI | 1114708138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188387) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: VA 0001279793) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2023-10-06 |