| NPI | 1487525812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0040318) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: OH 114564) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0040318) | |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-09-17 |