| NPI | 1518457910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0029755) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.444588) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2021-10-08 |