| NPI | 1902247075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.15545) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN66188) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2021-07-22 |