| NPI | 1215663323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031220) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0031220) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-11-03 |