| NPI | 1083600936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 184304) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 184304) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2013-01-15 |