| NPI | 1194103994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV APRN64727NP) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: WV 64727) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2017-04-05 |