| NPI | 1073328407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0038615) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 114879) |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-11-11 |