| NPI | 1215002233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9235869) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH NP04534) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |