| NPI | 1730811357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 113684) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 113684) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 113684) | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2022-07-27 |