| NPI | 1376088716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.021651) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 418011) |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2021-01-29 |