| NPI | 1679929269 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP18561) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010186) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2022-02-28 |