| NPI | 1568127439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 25322) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH 0029825) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2021-11-04 |