NPI | 1336832971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0137694) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 116304) |
363LF0000X Nurse Practitioner, Family (Licence: NY 352633) | |
Enumeration Date | 2023-05-30 |
Last Update Date | 2025-08-18 |