| NPI | 1982166310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH aprn.cnp.024402) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024402) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2019-08-21 |