| NPI | 1689077422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH 357780) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: OH 357780) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2016-03-11 |