| NPI | 1518453083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201901753NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024282) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024282) | |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2022-02-11 |