| NPI | 1831296250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 08095-NP) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-12-12 |