| NPI | 1083379663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.0030137) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WV 111960) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2022-09-07 |