| NPI | 1134664691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.019674) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3010977) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2022-04-19 |