| NPI | 1932610334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP026609) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9336982) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95007811) | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2022-03-22 |