| NPI | 1790227072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.306192) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.020648) | |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2018-11-06 |