| NPI | 1316389752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA 15214-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 306142-RN) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2014-05-03 |