| NPI | 1518345149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA17723NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 375877) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-07-29 |