| NPI | 1689943920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.12989) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.12989) |
| 363L00000X Nurse Practitioner (Licence: KY 3010862) | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2021-02-25 |