| NPI | 1699251777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.026620) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN100546-NP-C) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2020-05-11 |