| NPI | 1194027565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH COA 11591 - NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 430152 F) |
| 363L00000X Nurse Practitioner (Licence: OH COA.11591-NP) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2015-05-19 |