| NPI | 1811270291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 19574) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.12688-NP) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2022-07-21 |