| NPI | 1235725490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0028367) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 402414) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2021-06-17 |