| NPI | 1164252185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0037674) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN413867) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-11-14 |