| NPI | 1235844796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0034345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.491665) |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2024-12-13 |