| NPI | 1881999555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP12090) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 12090-NP) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: OH 12090-NP) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2021-05-26 |