| NPI | 1619104957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 849172) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 349791) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2022-11-16 |