| NPI | 1366216020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0035745) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 435037) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2024-01-25 |