| NPI | 1053872853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024416) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 261132) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 30379) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-07-26 |