| NPI | 1700070315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: VA 0024167461) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024167461) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2021-12-27 |