| NPI | 1720778079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH Aprn.Cnp.0033744) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033744) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2024-08-23 |