| NPI | 1932133410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH APRNCNP021898) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9202483) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-03-17 |