| NPI | 1548447931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH NP-09413) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH NP-09413) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2008-01-28 |