| NPI | 1508354689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011319) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 020871) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2025-08-04 |