| NPI | 1265171763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.422858) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5017092) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2024-08-06 |