| NPI | 1790191914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036883) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A004092) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2024-07-19 |