| NPI | 1871788505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0035833) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0035833) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024167465) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2025-03-26 |