| NPI | 1225425861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA17472NP) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.325771) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-07-29 |