| NPI | 1932454055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.13515) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 332898) |
| 163W00000X Registered Nurse (Licence: IN 28202989A) | |
| 363L00000X Nurse Practitioner (Licence: KY 3012203) | |
| 363LF0000X Nurse Practitioner Family (Licence: IN 71004030A) | |
| 363LF0000X Nurse Practitioner Family (Licence: OH COA.13515-NP) | |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2023-07-19 |