| NPI | 1396484374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0031266) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: OH F04220271) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-10-24 |