| NPI | 1699348573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024195206) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 25160) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 25160) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5015957) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 25160) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2026-06-01 |