| NPI | 1972376739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0038134) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH RN329565) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2024-11-27 |