| NPI | 1124435094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.16198-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.313227) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2017-06-23 |