| NPI | 1477943744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 19759) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WV APRN75848-AGPCNP-BC) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2022-02-09 |