| NPI | 1619384013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008511) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.15822-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV APRN88111) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3008511) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.15822-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV APRN88111) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2024-02-06 |