| NPI | 1265943880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.022337) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.402950) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2023-11-06 |