| NPI | 1720571433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024176152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0024176152) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2020-12-30 |