| NPI | 1891261301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179159) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC002468) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2021-07-22 |