| NPI | 1639223811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 102341) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 290596) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-06-05 |