| NPI | 1841635281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000017566) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171753) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2017-02-27 |