| NPI | 1952050205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031738) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0031738) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2024-02-23 |