| NPI | 1851843114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN60413-FNP-BC) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 1851843114) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2017-03-24 |