| NPI | 1417568973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179824) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R238285) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2023-03-30 |