| NPI | 1700948569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP009202) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH NP09068) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2009-06-29 |