| NPI | 1164710414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029899) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA RN531508) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2022-09-21 |