| NPI | 1235447434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: VT 101-0070819) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VT 101-0070819) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2022-08-09 |