| NPI | 1225435787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP014427) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN79286-NP-C) |
| Enumeration Date | 2014-11-28 |
| Last Update Date | 2024-06-12 |