| NPI | 1083009765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025714) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 19848) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2020-02-25 |