| NPI | 1881794188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH NP07414) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN282849) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-03-09 |