| NPI | 1932699584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024178529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 694894) |
| 163W00000X Registered Nurse (Licence: VT 026.0024171) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F343422-1) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2022-06-13 |