| NPI | 1750869061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH CNP.0031949) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ME CNP181152) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2022-08-27 |