| NPI | 1194596221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10022943) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.0035589) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-07-30 |