| NPI | 1760870554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC001587) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172252) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-167678) | |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2023-04-06 |