| NPI | 1750091872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0035249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.468974) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2024-03-05 |