| NPI | 1831397884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.09471-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 272088-COA1) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2014-04-24 |