| NPI | 1679140149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH LE-00036666) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.405428) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2021-06-04 |