| NPI | 1801131057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH COA.14807.NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0996683-NP) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2021-12-06 |