| NPI | 1598912628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.10182-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN.267227-COA1) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2022-11-03 |