| NPI | 1710439807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9486163) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.020107) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2020-07-30 |