| NPI | 1326481979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024165021) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001177356) |
| 163WG0000X Registered Nurse, General Practice (Licence: WV 50624) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0017137421) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 1177356) | |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2016-01-19 |