| NPI | 1003633751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 103150) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 103150) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-11-15 |