| NPI | 1649855776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0028735) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH 435287) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 1030202) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1153196) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 313836) | |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2024-10-30 |