| NPI | 1124083407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 06512-NP) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: OH RN260103) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3003467) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-04-22 |