| NPI | 1003151150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 13506-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007555) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2015-10-26 |