| NPI | 1023885514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.0037144) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.464170) |
| Enumeration Date | 2023-12-05 |
| Last Update Date | 2024-07-25 |