| NPI | 1326660721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024179611) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001262949) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-06-30 |