NPI | 1134860505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031509) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 381243) |
Enumeration Date | 2022-04-07 |
Last Update Date | 2022-06-27 |