| NPI | 1598908618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3006239) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 10681) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2018-09-19 |