| NPI | 1598331282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3016146) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: OH 132793) |
| 163W00000X Registered Nurse (Licence: KY 1141024) | |
| 163W00000X Registered Nurse (Licence: OH RN.403352) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0028942) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-02-17 |