| NPI | 1427305036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0033164) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9277514) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033164) | |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2023-11-14 |