| NPI | 1578117644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.025264) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH RN.361118) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2019-07-28 |