| NPI | 1811492820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9395646) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 0033751) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-02-07 |