| NPI | 1750602132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 18988) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: WA RN60258185) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60258141) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH RN.332736-1) | |
| Enumeration Date | 2010-06-19 |
| Last Update Date | 2023-04-06 |