| NPI | 1376857094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA-11601-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH NP 11601) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2023-03-07 |