| NPI | 1912667296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031991) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.0031991) |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95019207) | |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2024-01-15 |