| NPI | 1518951540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.10709-NP) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: OH COA.06850-NS) |
| 163W00000X Registered Nurse (Licence: OH RN260385) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2026-05-29 |