| NPI | 1386574069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0042629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 474497) |
| Enumeration Date | 2026-05-22 |
| Last Update Date | 2026-07-08 |