| NPI | 1275277006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP0031181) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 0031181) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-08-16 |