NPI | 1104553726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0032000) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0032000) |
Enumeration Date | 2022-08-03 |
Last Update Date | 2023-12-13 |