| NPI | 1174293138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 110892) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH RN.385551) |
| 207Q00000X Family Medicine (Licence: OH LE-00038485) | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-02-09 |