| NPI | 1063951952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.020424) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN.365677) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2025-08-11 |