| NPI | 1427027325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN251778) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: OH RN-290978) |
| 363LF0000X Nurse Practitioner Family (Licence: OH 10926-NP) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2020-10-05 |