| NPI | 1821646092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024678) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.024678) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.024678) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.024678) | |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2024-04-17 |