| NPI | 1386242139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.0026936) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0026936) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0026936) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2022-02-24 |