| NPI | 1174221923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.0033318) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033318) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-04-25 |