| NPI | 1083970446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.11810) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 2010004382) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-12-14 |