| NPI | 1437624236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 63040) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 63040) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-10-30 |