| NPI | 1619559952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0029538) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.421447) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2025-02-18 |