| NPI | 1326543190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024185339) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: SC 21672) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: VA 0024185339) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: SC 21672) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-06-27 |