| NPI | 1972169746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024617) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013341) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024617) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 3013341) | |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-03-13 |