| NPI | 1316037740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003305) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 06961-NP) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2015-05-05 |