| NPI | 1720531205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.019696) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN. 372501) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2022-10-07 |