| NPI | 1447505854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.13572) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4041927) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2025-06-06 |