| NPI | 1003486937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 0040797) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3016186) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2026-06-22 |