| NPI | 1194105775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH F06151039) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH 391711) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2026-07-07 |