| NPI | 1710336771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176539) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0024176539) |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: VA 0024176539) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2024-06-13 |