| NPI | 1376993311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995163-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.19252-NP) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2019-12-31 |