| NPI | 1679021497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020062) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 25705) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2023-06-19 |