| NPI | 1629701685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0031825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 377352) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-07-20 |