| NPI | 1770832404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 13037) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 296881) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2022-01-25 |