| NPI | 1275838344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.12003) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: OH COA.12003-NP) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2020-11-19 |