| NPI | 1366177719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0038311) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11020898) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2025-04-21 |