| NPI | 1518707066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 105393) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.0036217) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2025-01-21 |