| NPI | 1487395240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 39331) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 0030990) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-08-26 |