| NPI | 1538160403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP 08627) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71000544A) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-04-17 |