| NPI | 1124268628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH CNP023170) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 345925) |
| 163W00000X Registered Nurse (Licence: OH RN 345925) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2018-10-09 |