| NPI | 1992146740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.14647) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009646) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14647-NP) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2023-07-03 |