NPI | 1285021279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.17740-NP) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 370564) |
Enumeration Date | 2015-04-17 |
Last Update Date | 2015-08-12 |