| NPI | 1053667337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.13704) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH RN.325985) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2019-11-20 |