| NPI | 1154525137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.08521-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN.295875-COA1) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-05-06 |