| NPI | 1952616708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0030407) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.345811) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2022-02-10 |