| NPI | 1730344169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.12253-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 003841) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2011-05-20 |