| NPI | 1033161864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 337213) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 530731) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-07-30 |