| NPI | 1508228412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH COA.18838-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3009980) |
| 363LF0000X Nurse Practitioner Family (Licence: WV APRN34512NP) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-12-29 |