| NPI | 1861039430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027959) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.461770) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-11-01 |