| NPI | 1003832973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 79219) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA-07664) |
| 163W00000X Registered Nurse (Licence: IN 28147923A) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9256944) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-04-22 |