| NPI | 1174051122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 020585) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: OH 336842) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2022-07-21 |