| NPI | 1407340656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.023449) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.399298) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2020-10-26 |