| NPI | 1831074731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0040156) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.482692) |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-08-29 |