| NPI | 1700478682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0028390) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH Pending) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |