| NPI | 1578708467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI APRN-1292) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: OH NP-07175) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2013-09-11 |