| NPI | 1053774075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN421265) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2021-09-10 |