| NPI | 1972810802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA 11822-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.11822-NP) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2024-02-27 |