| NPI | 1154701837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.18016-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.334852) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2017-04-05 |