| NPI | 1881987394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 12323-NP) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH COA.12323-NP) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2020-03-19 |