| NPI | 1720478548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.19092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009047) |
| Enumeration Date | 2015-02-01 |
| Last Update Date | 2026-02-23 |