| NPI | 1215543582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0027551) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 2020012697) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2025-01-14 |