| NPI | 1881087658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011370) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 18437) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2021-05-05 |