| NPI | 1073916433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.17043-NP) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: OH 133153) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201012640) | |
| 163W00000X Registered Nurse (Licence: MI 4704265663) | |
| 163WF0300X Registered Nurse, Flight (Licence: OH 345531) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OH APRN.CNP.17043) | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: OH APRN.CNP.17043) | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2021-12-27 |