| NPI | 1578062188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP022341) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 392348) |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2020-12-29 |