| NPI | 1215476643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95008165) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.422395) |
| 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.020541) | |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2019-08-23 |