| NPI | 1982916946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.11575) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN312231) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2022-07-21 |