| NPI | 1417802828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0042284) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH RN.543070) |
| Enumeration Date | 2026-03-02 |
| Last Update Date | 2026-06-16 |