| NPI | 1205390721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024150) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 362502) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2022-01-25 |