| NPI | 1689026874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 18081) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH np-18081) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2021-12-27 |