| NPI | 1194340687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 96293) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WV 96293) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-05-21 |