| 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 |