| NPI | 1790105914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH COA.15957-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2003031294) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: MO 2014008350) | |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2017-02-08 |