| NPI | 1194293126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027751) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3012868) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2022-04-27 |