| NPI | 1932515731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.021547) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9356208) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95005203) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2018-09-13 |