| NPI | 1871825497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.15133) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN. 344514) |
| Enumeration Date | 2010-02-06 |
| Last Update Date | 2016-10-28 |