| NPI | 1952151250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0137152) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: VT 026.0146017) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-06-06 |