| NPI | 1730773508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0028449) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.417897) |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2023-11-03 |