| NPI | 1154082725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.0036262) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4018491) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2024-06-21 |