| NPI | 1578008835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020637) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: OH 394026) |
| Enumeration Date | 2016-12-22 |
| Last Update Date | 2023-03-02 |