| NPI | 1669896783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: OH 15112) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 15112) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2023-06-08 |