| NPI | 1255855292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 021415) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 362722) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2019-06-26 |