| NPI | 1629703095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH RN314700) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.0031864) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2024-04-17 |