| NPI | 1144271180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP04231) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH aprn.cnp.04231) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-12-19 |