| NPI | 1679983027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 219028) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN347183) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9441584) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.16306-NP) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2022-05-10 |