| NPI | 1679938500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH AG0116113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 365924) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2016-02-11 |