| NPI | 1831475649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.12015) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA12015-NP) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2020-03-12 |