| NPI | 1427791367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0031590) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH RN.485518) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-08-22 |