| NPI | 1073243523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033729) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN312078) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN312078) | |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2023-09-07 |