| NPI | 1316466915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021134) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.425339) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-01-25 |