| NPI | 1326463407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9414733) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16549-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV APRN75967-FNP-BC) | |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2022-12-06 |