| NPI | 1528299104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA 10818-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN 302547) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2009-07-30 |