| NPI | 1457924011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031666) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MD R208401) |
| 207Q00000X Family Medicine (Licence: MD R208401) | |
| 363L00000X Nurse Practitioner (Licence: MD R208401) | |
| 363L00000X Nurse Practitioner (Licence: MN 9268) | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2023-10-24 |