| NPI | 1982229605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRNCNP0027052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 302746) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-07-20 |