| NPI | 1164758165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM WAX Owner/Manager 804-402-6514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024164804) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2010-01-11 |