| NPI | 1659038925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0030564) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.402976) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2022-02-24 |