| NPI | 1396600094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.476027) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0041292) |
| Enumeration Date | 2025-12-16 |
| Last Update Date | 2026-01-28 |