| NPI | 1457876559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001235974) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-12-07 |