| NPI | 1831548247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173601) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: VA 0024173601) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2021-10-06 |