| NPI | 1972954469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.019609) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.381635-) |
| Enumeration Date | 2016-06-26 |
| Last Update Date | 2016-10-25 |