| NPI | 1619370905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.16607-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.305782-COA1) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2021-01-12 |