| NPI | 1649379744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14169-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 19071) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2017-03-27 |