| NPI | 1811929748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH RN-142445) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH NP04951) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-10-19 |