| NPI | 1679066914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 022855) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 55974) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-12-30 |