| NPI | 1306353016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.021640) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 432359) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-01-03 |