| NPI | 1952872160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024527) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.443733) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2021-04-07 |