| NPI | 1992237630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020417) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 9437) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 6903) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2024-06-18 |