| NPI | 1366614729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH COA.11172.NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 28177072A) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2020-11-17 |