| NPI | 1255796025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: OH APRN.CNP.18502) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.18502) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH COA.18502-NP) | |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2022-02-23 |