| NPI | 1336713148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024183385) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: VA 0001238326) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2022-02-23 |