| NPI | 1033543152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 70832) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14766-NP) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2018-06-20 |