| NPI | 1598068546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.11395-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN309959) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2021-12-27 |