| NPI | 1558503615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.026018) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: OH 026018) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3017379) | |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2022-09-14 |