| NPI | 1629554514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023063) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0103710-C-NP) |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2025-03-31 |