| NPI | 1801825245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002449) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA-06970-NP) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-08-22 |