| NPI | 1730526864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 17677) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 17677) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH CTP.19109) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3009651) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-01-25 |