| NPI | 1225143423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP04950) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH NP04950) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-11-11 |