| NPI | 1457906737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025361) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH APRN.CNP.025361) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2021-04-07 |