| NPI | 1629559042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023694) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.392099) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2019-01-09 |