| NPI | 1376089557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010940) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 024237) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2019-02-19 |