| NPI | 1174208441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0034434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.483311) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-08-01 |