| NPI | 1548110471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.40222) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.450615) |
| Enumeration Date | 2026-01-30 |
| Last Update Date | 2026-04-13 |