| NPI | 1851864607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 70623) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 70623) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2022-04-08 |