| NPI | 1356797054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1045702) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: OH RN.327298) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019597) | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2021-10-04 |