| NPI | 1538814819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11018116) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1117018) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0038461) | |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2025-07-02 |