| NPI | 1609659143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024187792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0024187792) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2024-04-11 |