| NPI | 1265116388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0035460) |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-12-12 |