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 |