| NPI | 1336336106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.09544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009855) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704309797) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.09544-NP) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2023-11-01 |