| NPI | 1598040008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.12858) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.12858) |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2025-12-22 |