NPI | 1194293985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.024142) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 430927) |
Enumeration Date | 2018-11-09 |
Last Update Date | 2019-01-31 |