| NPI | 1568438539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV APRN59184) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA vp005783l) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2022-11-15 |