| NPI | 1730460528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022820) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 57555) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2024-07-03 |