| NPI | 1265787402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.13440) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN.347538) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2021-01-20 |