| NPI | 1952185266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0037628) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.503993) |
| 247100000X Radiologic Technologist (Licence: OH R8875275) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-09-24 |