| NPI | 1447790910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH 020677) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: OH 348399) |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2021-12-30 |