| NPI | 1093195638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.17506) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1163663) |
| 163WG0000X Registered Nurse, General Practice (Licence: OH RN.344160) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3013540) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-01-13 |