| NPI | 1851750939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.18813-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9430640) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2017-01-09 |