| NPI | 1518319912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 19218) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.19218-NP) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2025-01-20 |