| NPI | 1316455942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 207LC0200X) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH LE-00022030) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2023-11-03 |