| NPI | 1124617733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 92471) |
| 163W00000X Registered Nurse (Licence: OH 410024) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 0028204) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 108120) | |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2023-05-29 |