| NPI | 1184277865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025204) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025204) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 104824) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-02-27 |