| NPI | 1346284221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH CNP10780) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.10780-NP) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: OH COA 10780 NP) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-08-07 |