| NPI | 1386034221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013402) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH NP16958) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2025-05-10 |