| NPI | 1124759659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0040671) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.427606) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2025-10-22 |