| NPI | 1780039412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH CNP.019485) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: OH RN.410571) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-09-01 |