| NPI | 1437141561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH NP07584) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN180620) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2012-10-02 |