| NPI | 1730475401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH NP-12217) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN.292449) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-01-14 |