| NPI | 1457783813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRNCNP14925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 354886) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 14925) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2018-07-10 |