| NPI | 1710558598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0029198) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029198) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029198) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2025-05-30 |