| NPI | 1003013079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.06938) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH NP 06938) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-03-19 |