| NPI | 1508112541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 13602) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2022-03-21 |