| NPI | 1073846044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.11095) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 21255) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21255) | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2017-09-25 |