| NPI | 1104487438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.412131) |
| 163WE0003X Registered Nurse, Emergency (Licence: OH RN.412131) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.024719) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024719) | |
| 363LC1500X Nurse Practitioner, Community Health (Licence: OH APRN.CNP.024719) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-09-03 |