| NPI | 1598521767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0036256) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN287419) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036256) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2025-01-06 |