| NPI | 1619299872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F340501-1) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.11203-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.11203 -NP) | |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2021-09-23 |