| NPI | 1598132003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 18152) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN 382984) |
| 363L00000X Nurse Practitioner (Licence: KY 3011557) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2021-11-23 |