| NPI | 1083354344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0035110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 476519) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-04-23 |