| NPI | 1740515741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.11232-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN218388) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP010826) | |
| 163W00000X Registered Nurse (Licence: PA RN275909L) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2011-01-07 |