| NPI | 1316345440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16719) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OH COA.16719-NP) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2023-11-03 |