| NPI | 1033583976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.18308) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.18308-NP) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2025-08-01 |