| NPI | 1003301524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023068) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.362164) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2019-03-06 |