| NPI | 1023018959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA VP007013M) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP008614) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.06674) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2017-02-03 |