| NPI | 1306298138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0028536) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN389422) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2021-07-09 |