| NPI | 1770050049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.023837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.361488) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2019-02-06 |