| NPI | 1801404207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033273) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0033273) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01041300) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2025-10-24 |