| NPI | 1730867417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0034185) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.430023) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-11 |