| NPI | 1578303392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0036418) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.436264) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0036418) | |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |