| NPI | 1992131445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.327283) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.15131-NP) | |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2023-10-08 |