| NPI | 1730617820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OH APRN.CNP.021183) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 357670) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.021183) | |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-07-28 |