| NPI | 1245637156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16825) |
| Additional Taxonomies | 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: OH COA16825NP) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2024-03-04 |