| NPI | 1952854960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN83720-FNP-BC) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP85005751) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2018-10-24 |