| NPI | 1770076101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351181) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.424143) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022968) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010294) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704318687) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2378929) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-01-17 |