| NPI | 1336808989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0029851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.471490) |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2021-12-10 |