| NPI | 1558709584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024170856) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001209239) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0017141048) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-07-16 |