| NPI | 1285247403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71010300A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0036972) |
| Enumeration Date | 2020-08-27 |
| Last Update Date | 2026-01-06 |