| NPI | 1740940147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 111616) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024183305) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024183305) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 111616) | |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2024-02-26 |