| NPI | 1902328503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021007) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.365570) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2022-11-08 |