| NPI | 1043445349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CA 20565) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.10630-NP) |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2011-11-17 |