| NPI | 1568089043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0027182) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH 409226) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-09-23 |