| NPI | 1871885483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.12900-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.332819-COA1) |
| Enumeration Date | 2011-05-15 |
| Last Update Date | 2012-05-10 |