| NPI | 1376178616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179587) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001224712) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2023-02-10 |