| NPI | 1497245062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.023425) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.308327) |
| 163W00000X Registered Nurse (Licence: OH RN308327) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-08-21 |