| NPI | 1982440749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0040698) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT F06241244) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-12-22 |