| NPI | 1306588454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031855) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.428017) |
| Enumeration Date | 2022-04-10 |
| Last Update Date | 2022-08-04 |