| NPI | 1720142268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP07037) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN280327) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2009-01-22 |