| NPI | 1336808989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0029851) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029851) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0029851) | |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2025-08-18 |