| NPI | 1538778162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 107149) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 107149) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2024-07-16 |