| NPI | 1598455347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0033896) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH RN.450907) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033896) | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2024-03-20 |