| NPI | 1851523039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016558) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.09427) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2024-10-29 |