| NPI | 1457888414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRNCNP021433) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 335768) |
| Enumeration Date | 2017-05-21 |
| Last Update Date | 2017-08-09 |