| NPI | 1467090415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021250) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036815) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11037015) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2025-01-09 |