| NPI | 1356197651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP035117) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036332) |
| 363L00000X Nurse Practitioner (Licence: PA SP035117) | |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2026-02-27 |