| NPI | 1982809828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3004900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.09136-NP) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2025-06-27 |