| NPI | 1427249499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH RX 09481) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 09481-NP) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2019-02-13 |