| NPI | 1780095281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.16074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.365402) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2019-06-06 |