| NPI | 1215380019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.019523) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 321669) |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2023-06-15 |