| NPI | 1235609934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.024360) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.428670) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2019-03-06 |