| NPI | 1598545303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188314) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001263450) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |