| NPI | 1841608320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16044-NP) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2026-04-21 |