| NPI | 1306158944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.11984) |
| Additional Taxonomies | 163WF0300X Registered Nurse Flight (Licence: OH RN270498) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2020-05-05 |