| NPI | 1447736939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP025404) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2483) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2023-11-03 |