| NPI | 1114764065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024191433) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MD R211442) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-01-15 |