| NPI | 1659633147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.13491) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.315551) |
| 363L00000X Nurse Practitioner (Licence: KY 3012588) | |
| 363L00000X Nurse Practitioner (Licence: OH COA.13491-NP) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2024-05-09 |