| NPI | 1396221115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025377) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.428237) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025377) | |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2021-01-29 |