| NPI | 1417313164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH RN.335279-COA1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16407) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2021-03-05 |