| NPI | 1588308951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0031207) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017707) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2026-08-12 |