| NPI | 1184879736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003519) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 10395) |
| 363L00000X Nurse Practitioner (Licence: IN 71001655A) | |
| 363L00000X Nurse Practitioner (Licence: OH 10395) | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2025-12-19 |