| NPI | 1932582202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17363-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN.326078-1) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2024-02-12 |