| NPI | 1497193007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN67007-FNP-BC) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 67007) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2023-04-04 |