| NPI | 1164997979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.023792) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH LE-00025353) |
| 163W00000X Registered Nurse (Licence: OH RN.342469) | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2019-05-07 |