| NPI | 1275906844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020256) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 93308) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2017-04-03 |