| NPI | 1871266262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029417) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH APRN.CNP.0029417) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2025-06-06 |