| NPI | 1255974283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025667) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025667) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2023-01-31 |