| NPI | 1932042546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0041814) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.465871) |
| Enumeration Date | 2026-04-10 |
| Last Update Date | 2026-04-10 |