| NPI | 1508272147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61499308) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA15992NP) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2026-04-06 |