| NPI | 1033880018 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0028508) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 0028508) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2025-02-12 |