| NPI | 1134639925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.021885) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH RN.375991) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2021-03-01 |