| NPI | 1538839824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024181517) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001306124) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2025-01-30 |