| NPI | 1477031847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023081) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP020441) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2019-07-17 |