| NPI | 1760797633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP0031210) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.506237) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11011987) | |
| 111N00000X Chiropractor (Licence: OH DC05171) | |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2024-12-06 |