| NPI | 1851684674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 20499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 353367) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 17756) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2025-02-19 |