| NPI | 1043883325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029210) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.420979) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-07-02 |