| NPI | 1245744598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021975) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007721A) |
| Enumeration Date | 2017-11-23 |
| Last Update Date | 2023-03-03 |