| NPI | 1487000386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.019790) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.410924) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.019790) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-02-07 |