| NPI | 1932955648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 113561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 113561) |
| Enumeration Date | 2024-04-24 |
| Last Update Date | 2024-09-17 |