| NPI | 1588370456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033157) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3018912) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2024-01-04 |