| NPI | 1053831800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020941) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH RN.360887) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-01-25 |