| NPI | 1447680756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019954) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA14996) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2022-09-27 |