| NPI | 1720242811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 16450) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH rn 309864) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2014-09-03 |