| NPI | 1942531538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA05336-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP 4502) |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: OH COA05336-NP) | |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: CA NP 4502) | |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |