| NPI | 1801534144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0040998) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 31235) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 31235) | |
| 363L00000X Nurse Practitioner (Licence: IN 71015172A) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2026-01-26 |