| NPI | 1932896313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0035221) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.505826) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-10-24 |