| NPI | 1770964157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.17702) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17702-NP) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2020-11-20 |