| NPI | 1457090979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0031478) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.430317) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2022-07-01 |