| NPI | 1710561527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024182760) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: VA 0001225775) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2022-12-02 |