| NPI | 1477033389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 025184) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH 388067) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-09-12 |