| NPI | 1952158529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.0036446) |
| Additional Taxonomies | 261QE0002X Clinic/Center Emergency Care (Licence: OH 356853) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-23 |