| NPI | 1891259685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN68831-FNP-BC) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0037678) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2024-12-04 |