| NPI | 1639314164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.09750) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA 09750 NP) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: OH COA-NS09649) | |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2023-07-28 |