| NPI | 1073820205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006582) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 11772-NP) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2015-05-04 |