| NPI | 1326654906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027766) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 1326654906) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH RN341980) | |
| Enumeration Date | 2020-09-19 |
| Last Update Date | 2025-05-05 |