| NPI | 1730857178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.407853) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-10-01 |