| NPI | 1326654906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027766) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN341980) |
| Enumeration Date | 2020-09-19 |
| Last Update Date | 2020-12-22 |