| NPI | 1104164573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA14235NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA-14235-NP) |
| Enumeration Date | 2013-01-19 |
| Last Update Date | 2016-04-05 |