| NPI | 1639558711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17410) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.273386) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-09-17 |