| NPI | 1619331980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.19028) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA19028) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-04-27 |