| NPI | 1477689719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA.065446-NP) |
| Additional Taxonomies | 163WC1400X Registered Nurse, College Health (Licence: OH RN275146-COA1) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2025-09-11 |