| NPI | 1609620426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036858) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.0036858) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2026-08-24 |