| NPI | 1194758029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003742) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.06624-NP) |
| 363L00000X Nurse Practitioner (Licence: OH COA.06624-NP) | |
| 163W00000X Registered Nurse (Licence: OH RN.178465-1) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3003742) | |
| 163W00000X Registered Nurse (Licence: KY 1097793) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-03-21 |