| NPI | 1497488423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024184882) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC NP1056473) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-10-24 |