| NPI | 1700306230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 021018) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.021018) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2025-02-03 |