| NPI | 1699024406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA 138666NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.317986) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2022-03-01 |