| NPI | 1598490773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0032451) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.355944) |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-10-13 |