| NPI | 1356856108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021899) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN78703-NP-C) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2018-08-14 |