| NPI | 1285297127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.024717) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NH 111522-23) |
| 363LF0000X Nurse Practitioner Family (Licence: OK 221019) | |
| 363LF0000X Nurse Practitioner Family (Licence: OH 422621) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2025-05-01 |