| NPI | 1366971103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 020957) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71012737A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71012737A) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-11-16 |