| NPI | 1548940299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP0034498) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.457132) |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-10-02 |