| NPI | 1306994538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI NPP37387) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.NP.0042281) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2026-06-24 |