| NPI | 1417905530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003001) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 06154) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-08-30 |