| NPI | 1336383124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.10549-NP) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH RN.346093-COA1) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2012-03-07 |