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 |