| NPI | 1912132028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.15871-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9264372) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN0996867) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2023-06-02 |