| NPI | 1447832787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0028634) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4018982) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-05-01 |