| NPI | 1376909259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH RN.364547) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.19032) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV APRN78001-FNP-BC) | |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2017-12-19 |