| NPI | 1932561719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3009917) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.18517) |
| 363L00000X Nurse Practitioner (Licence: IN 71008092A) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-07-31 |