| NPI | 1801312707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021384) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN.382065) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.021384) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2024-07-01 |