| NPI | 1841023355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024191381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001261026) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2024-10-07 |