| NPI | 1710165691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 09902) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 303454) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2018-03-13 |