| NPI | 1205585551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0031529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.485368) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2023-08-17 |