| NPI | 1982384129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34307) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024187654) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-10-18 |