| NPI | 1982409108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0038711) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.497422) |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-03-21 |