| NPI | 1760139364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.0030925) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH LE-00040326) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-11-06 |