| NPI | 1922385954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 2010005436) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 20100161) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-12-09 |