| NPI | 1326357849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH CNP020396) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.020396) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH CNP020396) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH CNP020396) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2022-03-05 |