| NPI | 1083434732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0038281) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: OH RN.364679) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2025-01-22 |