| NPI | 1033395801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN CNP 17771) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3003806) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2017-06-09 |