| NPI | 1689186694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.021991) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 113622) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2022-10-04 |