| NPI | 1073928537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9396930) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: OH COA.16064-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16064-NP) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-11-04 |