| NPI | 1497247274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 023524) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 417080) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-09-05 |