| NPI | 1841086204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0042069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.531650) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2026-08-01 |