| NPI | 1952933053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179997) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 27036) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2022-08-11 |