| NPI | 1366809816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA MS5575292) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 343838) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019379) | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2021-01-28 |