| NPI | 1003281064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025494) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH RN.417935) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2020-02-20 |