| NPI | 1659700599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA 2304159) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.15334) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OK 110868) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2018-12-03 |