| NPI | 1134464951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 020782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 387037) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2022-03-21 |