| NPI | 1285488205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036946) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 519396) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-11-20 |