| NPI | 1679050025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.023367) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRNCNP023367) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2023-03-24 |