| NPI | 1609515576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0031408) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.404338) |
| 163W00000X Registered Nurse (Licence: FL RN9454175) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-03-13 |