| NPI | 1952640146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH RN363464) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.14275NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.14275) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2024-01-02 |