| NPI | 1811140452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH COA.13772-NP) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT001575) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2014-07-01 |