| NPI | 1710462395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012698) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0030172) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV APRN79987NO) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2022-10-20 |