| NPI | 1154568566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA 18172-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 356661-1) |
| 374U00000X Home Health Aide | |
| 376K00000X Nurse's Aide (Licence: OH 400696841207) | |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2021-07-14 |