| NPI | 1356079727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0032187) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 363LA2100X) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2023-08-07 |