| NPI | 1811412158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0024175245) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2025-01-06 |