| NPI | 1245488410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN96666-NP-C) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV APRN96666-NP-C) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3005882) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WV APRN96666) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 20876) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020182) | |
| 363L00000X Nurse Practitioner (Licence: KY 3005882) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3005882) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 20876) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.020182) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2023-10-19 |