| NPI | 1992522973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0137417) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VT 026.0117774) |
| 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0137417) | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-02-11 |