| NPI | 1164784351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.13528) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.327840) |
| 163W00000X Registered Nurse (Licence: KY 1162168) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3013282) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2019-04-08 |