| NPI | 1265827844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 19126-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009248) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-09-12 |