| NPI | 1962805853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0027536) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN394733) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2021-06-11 |