| NPI | 1669989646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 372231) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2018-07-31 |