| NPI | 1568713055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP012269) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027086) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK APRN.CNP.0027086) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2023-09-10 |