| NPI | 1386361236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0032934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.451691) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2023-01-09 |