| NPI | 1710654702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0029875) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH F07210554) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-10-11 |