| NPI | 1285297127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.024717) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH 422621) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2019-08-18 |