| NPI | 1912389214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 17667NP) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2016-01-07 |