| NPI | 1922460385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019805) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.353490) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-09-20 |