| NPI | 1053041822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033834) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 113551) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-01-09 |