| NPI | 1255743001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.15936-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.364569) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-01-25 |