| NPI | 1992116065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.15705) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: OH 15705) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2018-03-17 |