| NPI | 1316425598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP025308) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025308) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP025387) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023271) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2026-01-04 |