| NPI | 1316370992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV APRN72998) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 72998) |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2025-05-08 |