| NPI | 1235696816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 023691) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.023691) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2022-04-14 |