| NPI | 1407505753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH APRN.CNP.0031985) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.485606) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-08-29 |