| NPI | 1134509342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17488-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.358703) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2017-01-30 |