| NPI | 1427146562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002990) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.05468) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-12-02 |