| NPI | 1376144469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRNCNP0029904) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH 419642) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2022-02-23 |