| NPI | 1063080372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH 0028790) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 0028790) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-06-28 |