| NPI | 1841548864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA 13752 NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 327336) |
| Enumeration Date | 2012-08-23 |
| Last Update Date | 2013-12-02 |