| NPI | 1871806984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 021874) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 138303) |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2018-12-17 |