| NPI | 1932299161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 09051NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 09051) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-12-18 |