| NPI | 1043614910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.16695) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 343757) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16695) | |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2021-01-15 |