| NPI | 1972212330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185516) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 32596) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2024-09-25 |