| NPI | 1114912029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 08430-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 212898) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-08-07 |