| NPI | 1821306598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95006360) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA11662NP) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2021-02-18 |