| NPI | 1407558075 |
|---|---|
| Former Name | CHAD THOMAS AMOS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102209786) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-05-28 |