| NPI | 1538686464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: OH APRN.CNP.021668) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.021668) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-01-04 |