| NPI | 1811324866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.15104) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA 15104-NP) |
| Enumeration Date | 2013-10-06 |
| Last Update Date | 2019-10-10 |