| NPI | 1972297786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0035563) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11026519) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-06-28 |