| NPI | 1881208536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.434721) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2023-05-06 |