| NPI | 1972990836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0028127) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 390421) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2020-12-04 |