| NPI | 1750792735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.16145) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN347001) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.16145-NP) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2019-09-12 |