| NPI | 1508967118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH APRN.CNP.05170) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN-241409) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2024-03-06 |