| NPI | 1699303735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025987) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH Aprn.cnp.025987) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2021-05-25 |