| NPI | 1285208595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0027661) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.458990) |
| 314000000X Skilled Nursing Facility | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027661) | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-05-20 |