| NPI | 1710524459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022242) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.446603) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2021-10-26 |