| NPI | 1720852650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0035730) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.478554) |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2024-06-05 |