| NPI | 1356698021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 13677) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.13677) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2021-03-03 |