| NPI | 1730742719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024924) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.214293) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024924) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2020-12-21 |