| NPI | 1760258735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH APRN.CNP.0035780) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.510002) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2024-05-31 |