| NPI | 1841744760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.19199) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO C-APN.0105862-C-NP) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2026-01-30 |