| NPI | 1760867733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17761-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012406) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2023-08-28 |