| NPI | 1285272849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.026230) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH F01200916) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.026230) | |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2023-12-06 |