| NPI | 1851801229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP017966) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP017966) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 0037598) | |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2024-09-26 |