| NPI | 1003265364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.19152) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.19152-NP) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-12-18 |