| NPI | 1225484918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRNCNP019580) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.342179) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-09-16 |