| NPI | 1841769700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012929) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024016) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 58355) | |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2023-11-27 |