| NPI | 1598352288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.026099) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 105018) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2024-06-10 |