| NPI | 1306358601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3013753) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020630) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2019-09-05 |