| NPI | 1740537679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA-13802-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP13802) |
| 363L00000X Nurse Practitioner (Licence: KY 3010566) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2021-11-24 |