| NPI | 1689129918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019833) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.019833) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2024-04-09 |