| NPI | 1134613201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95016249) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.022953) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022953) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.022953) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-01-20 |