| NPI | 1851762058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.18264) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA. 18264-NP) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2019-10-23 |