| NPI | 1821423401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10394) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.15330-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71004628A) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2022-04-12 |