| NPI | 1932589959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 98711) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 2301792) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-01-11 |