| NPI | 1720544232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 4035700) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP024295) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024295) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2025-02-24 |