| NPI | 1831959519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0038425) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.501254) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2025-01-29 |