| NPI | 1013155258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP01942) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA03615) |
| 163W00000X Registered Nurse (Licence: OH RN259257) | |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2019-06-21 |