| NPI | 1679238851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024183150) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000030310) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-08-15 |