| NPI | 1427309251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024186157) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0121-000682) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2023-02-15 |