NPI | 1497020101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 63391) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169893) |
Enumeration Date | 2012-03-13 |
Last Update Date | 2024-06-10 |