| NPI | 1336599000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: OH APRN.CNP.022805) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.022805) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2019-12-28 |