| NPI | 1932484821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH COA.14202-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP011836) |
| 363LF0000X Nurse Practitioner Family (Licence: OH COA.14202-NP) | |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2013-04-01 |