| NPI | 1629628565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WV 104506) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.0030032) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2021-12-15 |