| NPI | 1265182596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0032370) |
| Additional Taxonomies | 163WR0400X Registered Nurse Rehabilitation (Licence: OH RN.485291) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2023-10-17 |