| NPI | 1184277857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0027550) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71009145A) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-10-30 |