| NPI | 1265255103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.0038558) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.493252) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2025-01-29 |