| NPI | 1528632080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0029224) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.453246) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-07-07 |