| NPI | 1629806872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024198218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001301746) |
| 163W00000X Registered Nurse (Licence: DC RN500006216) | |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2026-07-29 |