| NPI | 1205220514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.17274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 358522) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2016-09-25 |