| NPI | 1043579345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CCP.0029818) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4281) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2021-10-26 |