| NPI | 1770276230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RN.419967) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2024-02-12 |