| NPI | 1457378044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002333) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH NP085181) |
| 363L00000X Nurse Practitioner (Licence: IL 041-306933) | |
| 363L00000X Nurse Practitioner (Licence: IN 71003857A) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-08-14 |