| NPI | 1215588033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH CNP.025755) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 405604) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2023-12-22 |