| NPI | 1871160143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0037024) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0037024) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11012101) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-08-20 |