| NPI | 1295474047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0031415) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 436947) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-06-01 |