| NPI | 1851751630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0030557) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130409) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2023-11-21 |