| NPI | 1871241349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 111232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN666940) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP024861) | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-03-14 |