| NPI | 1255058160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185579) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024185579) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |