| NPI | 1518782812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0038151) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11036526) |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2024-11-20 |