| NPI | 1548846785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029029) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3016185) |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2024-06-06 |