| NPI | 1194977900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA10338-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.10338-NP) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2012-08-07 |