| NPI | 1932416179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 78769) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 00105259) |
| 163W00000X Registered Nurse (Licence: WV 78679) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 2010007619) | |
| 101YM0800X Counselor, Mental Health (Licence: WV 00105259) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2022-07-21 |