| NPI | 1528579497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.373679) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2024-03-28 |