| NPI | 1902333073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 063006-23) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 020786) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2021-11-12 |