| NPI | 1528339702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 17724) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5006264) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209027973) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0036491) | |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2024-12-27 |