| NPI | 1437214608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 08796) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA08796 NP) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.08796) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-08-15 |