| NPI | 1265786479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.025023) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209010003) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2019-07-10 |