| NPI | 1194949453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA.07899-NP) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: OH COA.07899-NP) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2019-04-16 |