| NPI | 1811515521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.026353) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.400163) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2022-09-27 |