| NPI | 1255596037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.10093.NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 8787) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-11-22 |