| NPI | 1508408790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024647) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 024647) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2024-07-23 |