| NPI | 1275110280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024181168) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: VA 0001286879) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024181168) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2021-08-25 |