| NPI | 1689350043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0034052) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0034052) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |