| NPI | 1053666586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0032256) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OH 401265240711) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2024-05-07 |