| NPI | 1942674882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024190496) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0121001024) |
| 163W00000X Registered Nurse (Licence: VA 0001310221) | |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2024-06-20 |