| NPI | 1720544232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024295) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP024295) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2023-03-24 |