| NPI | 1710469481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: VT 101.0134186) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: VT 101.0134186) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: VT 101.0134186) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |