| NPI | 1912371717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 120556) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015393) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002114) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP015393) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP022998) | |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2025-06-24 |