| NPI | 1033639935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRNCNP021065) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 021065) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2017-07-25 |