| NPI | 1972190387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 107926) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 107926) |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2022-04-08 |