| NPI | 1255528725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH RN-303351) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: OH NP09579) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2022-07-21 |